Posted on
December 18, 2009 by
BirthingBeautifulIdeas
There are countless barriers to breastfeeding in the United States and other countries, but one that I don’t often see addressed often is the disjointedness of breastfeeding-related care.
In fact, for most women giving birth in the US, there is no continuity of care when it comes to breastfeeding.
And because of this, I think that woman who plan to breastfeed their babies (or who would breastfeed their babies if given accurate information) get ”lost in the lactation shuffle.” They find themselves swimming in a sea of individuals who a) have jobs in which they give pregnant women and new mothers advice and information about breastfeeding but b) most likely do not communicate with one another about breastfeeding in general and about specific women’s breastfeeding needs in particular and c) have varying levels of breastfeeding expertise.
For instance, a birthing woman in the United States will most likely encounter the following breastfeeding-related care providers throughout her pregnancy and postpartum period:
- The nurse(s) in her OB-GYN or midwife’s office
- Her OB-GYN or midwife
- Her labor and delivery nurse(s)
- Her postpartum nurse(s)
- An in-hospital lactation consultant
- Her child’s pediatrician
And notably, with the exception of the lactation consultant, none of these care-providers are trained in treating and addressing all issues related to breastfeeding. Some are trained to treat the mother, some the newborn. Some are trained to discuss breastfeeding prenatally and in the immediate postpartum period, while others have further expertise in offering treatment and advice throughout the later stages of breastfeeding.
With such a disjointed “system” of breastfeeding support, I think that it is often the case that many women with resolvable breastfeeding problems (such as most issues related to latch, positioning, supply, tongue-tie, pumping, inverted nipples, and even those issues related to a misunderstanding about the benefits of breastfeeding) do not receive the right help at the right time and/or from the right person.
For example, a woman who may have benefited from discussing the health and financial advantages of breastfeeding during her prenatal appointments may not hear about those advantages until she learns about them from her labor and delivery nurse, after which she has already decided to feed her baby formula.
A new mother who could have developed a strategy (in conjunction with her OB-GYN or midwife) for breastfeeding with inverted nipples may not even learn that she has inverted nipples until her postpartum nurse identifies them.
A woman recovering from a cesarean section might not learn about the football hold (a position which helps to relieve pressure on a tender incision site) until she meets the in-hospital lactation consultant, who might not be available until the day after her baby is born.
A new mother who begins formula-feeding her newborn after her obstetrician incorrectly informs her about the nutritional and immunological value of colostrum may not learn about how important it is for newborns to receive colostrum until she speaks with her pediatrician days after her child’s birth.
Moreover, even if a woman seeks additional assistance with nursing, either during pregnancy or after the birth of her child, she must wade through yet another sea of breastfeeding professionals and advocates, such as:
- A breastfeeding class instructor (such as a lactation educator or lactation consultant)
- A WIC peer counselor
- Her doula
- An independent lactation consultant
- Her local La Leche League leaders
What’s more, the above-mentioned individuals are often only available to women who have the means, the time, the knowledge, and the access to seek additional breastfeeding support.
Finally, in addition to birth professionals, lactation consultants and educators, doulas, and other breastfeeding advocates, new moms must also filter through the advice given to them by friends, family, spouses, partners, and even strangers, whose breastfeeding support (or lack thereof) can have a significant impact on one’s attempts to begin and continue breastfeeding.
I suspect that having a “thread” to connect the dots between all of the breastfeeding-related care providers and advocates would help not only to increase the numbers of women who choose to breastfeed but also to assist those women who want to and can breastfeed but do not receive the proper continuous support.
Sometimes doulas can function as this sort of “thread,” giving breastfeeding information to women in the prenatal period, offering support with latch and positioning in the immediate postpartum period, and being available for questions and referrals in the later postpartum period.
Other times, knowledgeable family members or friends can also take up this role.
But not everyone has access to these individuals.
So in my ideal world, there would be someone in all OB-GYN and midwives’ offices who could meet with women prenatally and postnatally to discuss, troubleshoot, and support a mother’s breastfeeding efforts.
Someone who could refer women to lactation consultants, educators, doulas, and breastfeeding support groups when needed.
Someone who could talk about the benefits of breastfeeding well before a woman gives birth.
Someone who could respectfully support mothers who choose to formula feed, including (and perhaps especially) those who planned on and wanted to breastfeed.
Someone who would be able to communicate with in-office nurses and OB-GYNs and midwives and labor and delivery nurses and postpartum nurses and lactation consultants and doulas.
Someone whose services would be included in the prenatal and postnatal care that a woman is already receiving.
Available. Accessible. And continuous.
Wouldn’t it be nice?